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Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve

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Abstract

Background

Robotic groin hernia repair (r-TAPP) is demonstrating rapid adoption in the US. Barriers in Europe include: low availability of robotic systems to general surgeons, cost of robotic instruments, and the perception of longer operative time.

Methods

Patients undergoing r-TAPP in our start-up period were prospectively entered in the EuraHS database and compared to laparoscopic TAPP (l-TAPP) performed by the same surgeon within the context of two other prospective studies. Operations were performed with the daVinci Xi robot and the primary endpoint was skin-to-skin operative time.

Results

Following proctoring in September 2016 by US surgeons, 50 r-TAPP (34 unilateral and 16 bilateral) procedures have been performed up to January 2017. Mean operative time for unilateral r-TAPP was 54 min, with a decrease from 63 min for the first tertile to 44 min for the third tertile. For unilateral l-TAPP, the mean operative time was 45 min. Mean operative time for bilateral r-TAPP was 78 min, with a decrease from 90 min for the first half to 68 min for the second half. For bilateral l-TAPP, the mean operative time was 61 min. There were no intraoperative complications and no conversions to conventional laparoscopy or open surgery. The operation was performed as an outpatient in 67% of cases. Urinary retention requiring urinary catheterization was the only early postoperative complication noted in 5 patients (10.2%). At 4 week follow-up, 7 patients (14.3%) had an asymptomatic seroma, but no other complications were seen.

Conclusion

Robotic TAPP was associated with a rapid reduction in operative time during our learning curve and afterwards the operative time to perform a robotic TAPP equals the operative time to perform a laparoscopic TAPP, both for unilateral and for bilateral groin hernia repairs. No complications related to the introduction of robotic-assisted laparoscopic groin hernia repair were observed.

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Funding

The study is investigator initiated and was funded with a research grant from the Committee for innovation of Maria Middelares Ghent, Belgium. The cost for the independent statistical analysis was funded by BVBA Dokter Filip Muysoms.

Author information

Authors and Affiliations

  1. Department of Surgery, Maria Middelares, Buitenring Sint-Denijs 30, 9800, Ghent, Belgium

    Filip Muysoms, Stijn Van Cleven & Iris Kyle-Leinhase

  2. Center for Minimally Invasive and Robotic Surgery, Phoenix, AZ, USA

    Conrad Ballecer

  3. Department of Surgery, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA

    Archana Ramaswamy

Authors
  1. Filip Muysoms
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  2. Stijn Van Cleven
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  3. Iris Kyle-Leinhase
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  4. Conrad Ballecer
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  5. Archana Ramaswamy
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Corresponding author

Correspondence to Filip Muysoms.

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Conflict of interest

Outside the study Dr. Filip Muysoms reports research grant and consultancy fees from Medtronic, research grant and speakers fees from Johnson & Johnson, research grants and speakers fees from Dynamesh, proctoring contract and consultancy fees for Intuitive Surgical. Dr. Conrad Ballecer reports consultancy fees from Intuitive Surgical and Bard Davol. Dr. Archana Ramaswamy reports consultancy fees from ValenTx. Dr. Stijn Van Cleven and Dr. Iris Kyle-Leinhase have no conflicts of interest or financial ties to disclose.

Additional information

Study registration

The study protocol was submitted at ClinicalTrials.gov (NCT0975401) before the start of the study.

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Muysoms, F., Van Cleven, S., Kyle-Leinhase, I. et al. Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve. Surg Endosc 32, 4850–4859 (2018). https://doi.org/10.1007/s00464-018-6236-7

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  • DOI: https://doi.org/10.1007/s00464-018-6236-7

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